Healthcare Provider Details

I. General information

NPI: 1740862473
Provider Name (Legal Business Name): CHRISTINE ASHLEY CLERMONT-AUDEVERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 MANCHESTER EXPY
COLUMBUS GA
31904-6878
US

IV. Provider business mailing address

144 LEE ROAD 2021
PHENIX CITY AL
36867-0970
US

V. Phone/Fax

Practice location:
  • Phone: 706-596-4000
  • Fax:
Mailing address:
  • Phone: 305-336-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1-162996
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: